Same Day Discharge in uncomplicated PCI safe and cost effective, reveals Canadian study

Same Day Discharge (SDD) is safe after uncomplicated Percutaneous Coronary Intervention (PCI) revealed a study published in the Journal of the American Heart Association (JAHA).

Overcrowding and bed shortage are two main issues faced by government and private hospitals worldwide. The problem is more prevelent in developing and heavily populated countries like India. The present study, although has been conducted in a Canadian set-up but it provides a strategy to overcome the crisis.

Percutaneous Coronary Intervention is becoming increasingly popular as an effective invasive cardiac therapy worldwide. Same Day Discharge after uncomplicated and elective PCI is practiced by many health care facilities in order to manage bed shortages and overcrowding. Advancement in stent technology and adjunctive pharmacology and increased use of radial access during PCI procedures, reducing periprocedural myocardial infarction (MI) and vascular access-site complications have enabled this practice. However, the data insufficiency about the safety of this practice makes it highly questionable.

The present study was conducted aiming at ascertaining the safety of Same-day discharge after percutaneous coronary Intervention where the complications are less.

The authors evaluated outpatients undergoing elective PCI in Ontario, Canada, from October 2008 to March 2016. For this study, SDD was defined when patients were discharged on the day of PCI, and non-SDD was defined as those patients who had 1 overnight stay.

The primary outcome was 30-day all-cause death or hospitalization for acute coronary syndrome. Inverse probability of treatment weighting with propensity score was used to account for differences in baseline and clinical characteristics between SDD and non-SDD groups.

Among 35 972 patients who underwent elective PCI at 17 PCI centers in Ontario, 10 801 patients (30%) had SDD PCI and 25 121 patients (70%) had non-SDD PCI. Substantial hospital variation for SDD PCI was observed, ranging from 0% to 87% during the study period. In the propensity-weighted cohort, SDD patients had no significant difference in 30-day rates of death or hospitalization for acute coronary syndrome compared with non-SDD patients. SDD and non-SDD patients also had no significant difference in 30-day rates of mortality or coronary revascularization.

Based on the results of the study authors concluded that SDD after PCI is safe. Further, they added that increased adoption of this strategy could lead to improved bed-flow efficiency and substantial savings for the Canadian healthcare system without comprising outcomes.